Chemotherapy-related toxicity for older adults with cancer may decrease when patients receive geriatric assessment-driven interventions, according to new clinical trial results.
Investigators from the City of Hope, a private, not-for-profit clinical research center based in Duarte, California, found significantly fewer treatment-related side effects when a multidisciplinary team of experts analyzed each case and provided patients with personalized interventions.
Patients in the intervention group experienced a 10% reduction in moderate side effects — without significant chemotherapy modifications or dose reductions when compared to the control group.
Notably, patients in the intervention group were also 15% more likely to complete an advance directive when compared to their peers in the control group. The intervention appeared to make no difference in overall survival.
“The ability to tolerate treatment and not be miserable is equally as important, if not more important, than survival to older adults,” Daneng Li, M.D., assistant professor in City of Hope’s Department of Medical Oncology & Therapeutics Research said.
Pinpointing patients’ vulnerabilities
The researchers randomly divided 605 study participants aged 65 years and older who were starting a new chemotherapy regimen into two cohorts. One received standard of care and the other received the cancer-specific geriatric assessment using a tool developed by the researchers. The assessment evaluates areas such as physical ability, co-existing health conditions, nutrition and mental health.
Participants were provided with recommendations from specialists who recommended additional services based on patient vulnerabilities. Specialists included an oncologist, nurse practitioner, social worker, physical or occupational therapist, nutritionist, or pharmacist.
If a participant was found to have nutrition issues such as excessive weight loss, for example, they received dietary advice or were referred to an occupational therapist who could help to improve their eating abilities. If the patient was at risk of overmedication, a pharmacist would provide a drug therapy review and recommendations.
“The geriatric assessment that City of Hope pioneered is a form of precision medicine. It flags each patient’s individual vulnerabilities,” said Arthur Dale, City of Hope’s Coppola Family Chair in Supportive Care Medicine. “With the help of a multidisciplinary group of specialists, the patient is able to experience fewer side effects, is more likely to meet their care goals and, hopefully, will be able to return to normal life.”
The study was published in JAMA Oncology.